Improving Access to Healthy Foods in Washington State: A Policy Feasibility Study Overview & Preliminary Results July 2011 Donna Johnson, PhD, RD (Principle Investigator) Mary Podrabsky, MPH, RD Emilee Quinn, MPH 1 BACKGROUND June 2010 WA Food Systems Strategies Summit: CPHN presents the Opportunities for Increasing Access to Healthy Foods in Washington report for the Access to Healthy Foods Coalition (summit sponsor) Based on statewide stakeholder interviews, the report discussed barriers, needed resources and promising strategies. Governor Gregoire announces an executive order for interagency collaboration and a report assessing the state s food systems by December 2011 2 1
PURPOSE To assess the perceived impact, political feasibility and implementation feasibility of policies with reported potential for increasing access to healthy foods in Washington State Compare and contrast perceptions of various stakeholder groups Also: Finding the right balance between scientific rigor and practical utility 3 METHODS Compiled a list of policies with potential for increasing access to healthy foods basedon promising practices andstakeholder input Rounds of Data Collection Method Primary Purpose 1) National nutrition policy and food system experts (e.g., NOPREN members) 2) WA Stakeholders (e.g., WA NOPREN, advocates, program managers) 3) WA State Level Policymakers (e.g., legislators, gubernatorial staff) Online Survey Narrowed list of policies based on results Online Survey Narrowed list of policies based on results Online Survey Rate perceived impact of 50 policies Rate perceived impact, political feasibility & implementation feasibility of 40 policies Rate perceived political feasibility of 37 policies 4) Sample of survey respondents Interviews Explore rationales for perceptions NOTE: Study design based on work described in Brescoll, VL, R. Kersh and KD Brownell (2008). Assessing the feasibility and impact 4of federal childhood obesity policies. The ANNALS of the American Academy of Political and Social Science, 615: 178 194. 2
POLICY CATEGORIES Food Marketing Price Incentives Access to Food Retailers Community Planning & Land Use Nutrition POLICIES SAMPLE POLICY APPROACHES Menu labeling, school advertising, voluntary codes of practices Taxes on sugar sweetened beverages Business assistance, public private partnerships, tax incentives for fresh food retailers Revisions to the WA Growth Management Act, bans on restrictive land covenants Child Care: Licensing standards, linking CACFP participation to quality ratings Schools: Technical support for implementation of federal policy, mandating Compiled a list of participation policies in with voluntary potential federal for programs increasing access to healthy foods corresponding to 2010 report areas of opportunity and based on promising practices Guidelines and that stakeholder encourage or input require for state state agencies relevancy to purchase local foods Sample policies: Incentives and technical assistance for farmer cooperatives, tax Local Food Procurement Farmer Support & Agricultural Preservation Breastfeeding Other State Agencies: Nutrition standards for procurement, vending and meal service incentives/penalties for farmland preservation Funding for staffing and a worksite program, inclusion of breast pumps in statefunded health insurance Joint use agreement regulations, requirements for water availability in public 5 places PRELIMINARY RESULTS Highest Impact Subject Matter Experts (N= 49) Policy Mean (n) Tax SSBs at 2 cents/oz., directing revenue to obesity prevention 3.9 (49) Revise childcare licensing to reflect national guidelines and evidence 3.8 (43) Develop a public private partnership for fresh food retailer financing 3.7 (47) Issue state determined nutrition standards for participation in CACFP above and beyond the federal minimum standards 3.7 (36) Nutritional standards for foods/beverage in settings frequented by children 3.6 (49) Provide tax incentives for grocery stores locating in low income communities 36(47) 3.6 Prohibit advertising of unhealthy foods on school grounds 3.6 (47) Create consistent nutritional standards across various forms of licensed child 3.6 (44) care Require water availability in government facilities & outdoor areas 3.6 (46) Support schools in adhering to most recent USDA nutritional standards 3.5 (43) 6 *Bold text indicates that the policy is among top 10 highest rated for impact among all other stakeholder respondents 3
PRELIMINARY RESULTS Highest Impact Other Stakeholders (N= 45) Policy Mean (n) Fund pilot projects to build local/regional food distribution systems 4.1 (43) Support schools in adhering to most recent USDA nutritional standards 4.0 (44) Develop a public private partnership for fresh food retailer financing 4.0 (44) Make CACFP participation a standard of child care quality 4.0 (43) Urban planning grants to address access to farmers markets, CSAs and farmable 3.8 (42) land Create consistent nutritional standards across various forms of licensed child 38(42) 3.8 care Provide tax incentives for grocery stores locating in low income communities 3.8 (43) Fund Farm to School projects to increase the use of local foods in schools 3.8 (45) Revise childcare licensing to reflect national guidelines and evidence 3.7 (43) Establish incentives for food procurement through local farmer cooperatives 3.7 (40) 7 *Bold text indicates that the policy is among top 10 highest rated for impact among subject matter expert respondents PRELIMINARY RESULTS Political Feasibility (N=73) Policy Mean (n) Most Prohibit advertising of foods and beverages on school buses 3.7 (65) Prohibit advertising of unhealthy foods on school grounds 3.6 (64) Technical support for farmers markets to acquire/use EBT terminals 3.6 (70) Revise childcare licensing to reflect national guidelines and evidence 3.4 (57) Expressly permit and address liability of joint use agreements for schools and government facilities used for community purposes/kitchens 3.4 (63) Least Tax SSBs at 2 cents/oz., directing revenue to obesity prevention 26(70) 2.6 Fund a statewide breastfeeding coordinator 2.6 (61) State funds for infrastructure must not be detrimental to agriculture 2.5 (44) Levy taxes on the conversion to non farm uses of land designated for 2.4 (55) agricultural preservation Tax SSBs at 2 cents/oz. 2.4 (71) *Bold text indicates that the policy is among top 10 highest rated for impact among subject matter expert respondents 8 4
PRELIMINARY RESULTS Feasibility of Implementation (N=60) Policy Mean (n) Most Prohibit advertising of unhealthy foods on school grounds 4.0 (55) Prohibit advertising of foods and beverages on school buses 3.9 (54) Technical support for farmers markets to acquire/use EBT terminals 3.8 (58) Cover breast pump rentals or purchases for working mothers through 3.7 (50) state funded health insurance Fund media campaigns to promote healthy eating 3.6 (56) Least Issuestate determined state determined nutrition standards for participation in CACFP 30(45) 3.0 above and beyond the federal minimum standards Dinners served by state agencies: < 700 calories 2.9 (54) Nutritional standards for foods/beverage in settings frequented by 2.9 (57) children Lunches and dinners served by state agencies: < 800 mg. of sodium 2.9 (54) State funds for infrastructure must not be detrimental to agriculture 2.9 (42) 9 PURPOSE The ultimate question: What policies are seen as impactful and feasible? 10 5
PRELIMINARY OBSERVATIONS National experts more likely to emphasize the impact of policies based on mandates (vs. incentives or encouragement) I think anything with a mandate, requirement, etc. and with funding attached is more likely to make an impact than guidelines, suggestions, and voluntary programs. Voluntary" standards to limit advertising of less healthy foods in schools, restaurants, etc. may not be successful due to an enforcement issue. 11 PRELIMINARY OBSERVATIONS Among WA stakeholders: More challenging to identify consistent themes among WA stakeholders related to impact likely due to diversity of respondents. Considerable discussion about education and greater anti mandate sentiment #1 is education of young children on eating healthy. Include parenting food preparation classes on a budget. The ones most likely to succeed have to do with education. We need to impact people's thinking and starting with the very young. Younger parents and families have more of a chance to change. I think the policies that educate vs. mandate the consumer will build the "desire" for healthy food. Our job is to make sure that when someone makes the choice for healthy food they get the best tasting and most appealing food/meals. Too much regulation and mandates do not ensure a better system. 12 6
PRELIMINARY OBSERVATIONS Among WA stakeholders, cont d: Political feasibility: many references to cost, potential opposition, and perception that mandates limit choice and/orimpede profit Policies which appear to benefit the economy and environment or appear to have little negative impact on the economy are more likely to be embraced, adopted and implemented. Programs that promote business growth, [such as] infrastructure investments are more feasible than others. Policies that focus on regulations only are less feasible where they are perceived to take away local control or increase costs associated with the changes. Implementation ti feasibility: frequent references to availability of funding, resistance and/or lack of political will Requiring changes in procurement, sourcing more locally, etc. will have cost implications for schools, institutions, child care, etc. If there isn't a way to easily offset those costs, there will be reluctance/resistance to change. 13 CHALLENGES & LIMITATIONS Related to The nature of the sample: Convenience sample and self selection bias The nature of food system research: Many policy areas, resulting in longer survey and greater respondent burden Broad vs. narrow subject expertise The nature of policy feasibility/development research: Participation of all key stakeholders (e.g., policymakers and industry representatives) Nuances and biases associated with policy language Timing and logistics associated with political landscape (e.g., fiscal crisis, busy legislative session, new governor) 14 7
STATUS & NEXT STEPS Next steps: Conduct 10 20 interviews to better understand the rationales behind the ratings Data analysis, reporting and dissemination (July August) Intended audiences for dissemination: State Interagency Food System Workgroup State stakeholders and advocates, to inform priorities and areas for potentially fruitful advocacy National audiences interested in food policy feasibility 15 8